Patients Without Borders

Amid rising health costs, illegal immigrants in San Diego-area hospitals are being transferred back to Mexico for treatment.

Jose Lopez stole across the U.S. border with dreams of prosperity and a craving for adventure -- but his grand plans didn't last long.

On his second day as a fieldworker, a car wreck left him lying in a Brawley roadway with his right leg shattered. Lopez, 19, was taken to Scripps Memorial Hospital in La Jolla, where surgeons put a rod in his leg and wired his broken jaw shut.

As Lopez recuperated at the hospital, his bill mounted by the day, and Scripps had no choice but to absorb the cost. Lopez had no money, San Diego has no public hospital to take indigent patients, and federal rules bar hospitals from releasing patients prematurely.

A novel company came to the rescue.

Nextcare, a 2-year-old firm founded by an employee in the Scripps chain, arranged to take Lopez to a Tijuana hospital dedicated, in large part, to treating indigent Mexican patients brought home from U.S. hospitals.

And after two weeks in Tijuana, Lopez was back where he started, at his mother's one-room house in Sinaloa, 900 miles to the southeast, showing her his scars and speaking through clenched teeth.

Lopez's journey offers a glimpse into the pros and cons of a business that many in the hospital industry expect to flourish as health costs rise.

Nextcare, believed to be the first firm of its kind, so far has contracted with five U.S. hospitals to return about 50 uninsured illegal immigrant patients to Mexico.

The American hospitals pay the company to arrange transportation and treatment south of the border -- usually at Nextcare's Tijuana facility, Hospital Ingles. Patients must consent in writing to the transfers.

It's a bargain to hospitals on the California side of the border -- and perhaps beyond. The average stay in a California hospital costs $1,737 a day, but Nextcare's costs can be as low as $450 daily, the company said.

The tab for treating illegal immigrants is staggering in some areas. It was estimated at $200 million last year by U.S. hospitals near the Mexican border, according to a study of facilities in California, Arizona, New Mexico and Texas.

A study of the costs at Los Angeles County public hospitals and clinics put the total at roughly $340 million annually.

Sending such patients back to Mexico "is a responsible and inventive way of dealing with a shortage of beds for indigent patients," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "When you talk about our border states and counties like San Diego, they're tired of waiting for the federal government to deal with this problem."

At the same time, the transfers are raising concern among some U.S. physicians and immigrant advocates about whether the patients receive adequate care and whether the transfers amount to de facto deportations.

"I wonder whether or not people who are being transferred are misconstruing the voluntary nature and fearing other consequences," said Cecilia Munoz of the National Council of La Raza, an immigrants' rights group.

Dr. Rosemarie Johnson, a San Diego physician and member of the U.S.-Mexico Border Health Commission, said the quality of hospitals in Tijuana is highly variable and most have outdated equipment by U.S. standards.

"There are a huge number of them and they range from a cottage, like a beach cottage that people claim is a hospital and have a couple of beds, to state-of-the-art places that I have visited and are up to standards," Johnson said.

"Would I send my family there? No, not without knowing a whole lot about the quality of care."

George Ochoa, co-founder of Nextcare, says patients receive care in Mexico that is comparable to or even better than what they would get in the U.S. The company also stresses that the transfers are voluntary, the result of an unpressured discussion between Nextcare officials and the patient.

Although hospitals are prohibited from asking about patients' citizenship status when they arrive for treatment, Ochoa said the information often comes out in other ways -- for example, when staff members look into patients' eligibility for government insurance programs.

"We ... say, 'Let us take you out of this very expensive hospital and take you to our facility in Tijuana,' " he said. " 'The level of care you're going to receive is the same, maybe even better. You'll have a physician and nurses you understand. The food is something you're comfortable with. The TV is Mexican. You can call your home and have your family come and visit you.' "

Lopez agreed to be moved mainly because he was hungry.

He'd eaten little before the accident, waiting for a payday that never came. Then his jaw was wired shut and he was reduced to imbibing liquids and oatmeal. He longed for a good meal.

In June, Ochoa's founding partner in Nextcare, Bob Barraza, a retired businessman, visited Lopez's room at Scripps. Barraza offered to return him to a familiar diet, language and surroundings, without compromising his medical care.